Rheumatoid arthritis gets worse after menopause, likely because of lower hormone levels, according to a review of 8,189 women in the National Data Bank for Rheumatic Diseases, published recently in Rheumatology.

The investigators compared scores on the Health Assessment Questionnaire (HAQ) between 2,005 premenopausal women with a mean age of 39.7 years; 611 women transitioning through menopause with a mean age of 50.7 years, and 5,573 postmenopausal women with a mean age of 62.3 years. As participants in the data bank, the women completed a questionnaire at regular intervals that included the HAQ, which is a 3-point measure of functional status, with 0 meaning no disability and 3 severe disability. They had all been diagnosed with rheumatoid arthritis prior to menopause.

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After adjusting for income, age, RA duration, rheumatic disease comorbidity index, biologic therapy use, and other confounders, postmenopausal women scored a half point higher on the HAQ than did premenopausal women, and HAQ scores were 0.68 points higher in postmenopausal women, compared with premenopausal women of the same age. Transitioning through menopause increased HAQ scores 0.28 points, and the rate of climb in HAQ scores was steeper once women entered menopause.

“Women with RA have better functional status prior to menopause, even after controlling for covariates,” and after menopause, functional decline worsens and accelerates, said investigators led by Elizabeth Mollard, PhD, a nurse practitioner at the University of Nebraska Medical Center, Lincoln. The findings were “robust even after adjustment for other significant factors.”

The team also found that functional decline was less in women who had a longer reproductive life; had ever been pregnant; or had ever used hormone replacement therapy (HRT).

The findings support the notion that hormone exposure plays a role in RA severity, at least in women. It’s well known that RA activity trails off when women are pregnant, but increases after delivery, when hormone levels are returning to baseline. It’s also known that women who go through menopause early are at greater risk for developing RA. Longer reproductive life, pregnancy, and HRT use, meanwhile, all increase women’s hormonal exposure and were protective in the study.

“Women have changes in disease development and progression surrounding reproductive and hormonal events. ... Our results suggest further study on hormonal involvement in functional decline in women with RA,” the investigators said.

Menopausal stage was determined by survey response. Pregnant women and those with hysterectomies were excluded from the study, as were those who went through menopause before the age of 40 years, and those over the age of 55 who had not reported a menstruation cessation date.

There was no external funding for the work. Dr. Mollard had no disclosures.